Chronic breathlessness in adults: first-line tests

In the practice and imaging

• Pulse oximetry, ECG, chest X-ray, spirometry (not laboratory tests).

Laboratory tests

• FBC
• Serum electrolytes
• Serum creatinine with eGFR
• NT-proBNP (if heart failure possible)if needednon-French guidelineSuspected heart failure (orthopnoea, oedema, cardiac history, abnormal ECG): NICE recommends measuring NT-proBNP in anyone suspected of heart failure and sets referral thresholds ^[2].
• TSH (if signs of thyroid dysfunction or arrhythmia)if needednon-French guidelineHypothyroidism or hyperthyroidism possible: thyroid tests are among the “possible” initial tests of the general practice review ^[3] and among the tests to consider if heart failure is suspected ^[2].
• Alpha-1 antitrypsin (if emphysema or COPD before 40, little smoking or family history)if needednon-French guidelineCOPD or emphysema of early onset, light smoking or family history: look for alpha-1 antitrypsin deficiency ^[4]. See the “COPD” page.